Objective To investigate the early effectiveness of total percutaneous endovascular aneurysm repair (TPEVAR) in treating asymptomatic abdominal aortic aneurysm (AAAA) by comparing with surgical femoral cutdown endovascular aneurysm repair (SFCEVAR). Methods Between January 2010 and May 2011, 41 cases of AAAA were treated with TPEVAR in 26 cases (TPEVAR group) and with SFCEVAR in 15 cases (SFCEVAR group). The maximum tumor diameter ranged from 3.5 to 9.2 cm (mean, 5.7 cm) in TPEVAR group, and ranged from 3.5 to 10.0 cm (mean, 6.9 cm) in SFCEVAR group. There was no significant difference in gender or age between 2 groups (P gt; 0.05). Results All patients underwent EVAR successfully. The patients were followed up 6-23 months (mean, 13.5 months). No significant difference was found in the outer diameters of the delivery system for main body and iliac leg, operation time, contrast media dosage, hospitalization days, or postoperative hospitalization days between 2 groups (P gt; 0.05). The patients of SFCEVAR group had more bleeding volume and longer ICU stay than patients of TPEVAR group (P lt; 0.05). The incidence of minor complication was 7.7% (2/26) in TPEVAR group and 33.3% (5/15) in SFCEVAR group, showing no significant difference between 2 group (χ2=4.42, P=0.08); the incidence of major complication in SFCEVAR group (20.0%, 3/15) was significantly higher than that in TPEVAR group (0) (χ2=5.61, P=0.02). Conclusion TPEVAR shows safer and more effective than SFCEVAR in treating AAAA.
ObjectiveTo systematically evaluate the effectiveness and safety of fenestrated endovascular aortic repair (F-EVAR) and chimney endovascular aortic repair (Ch-EVAR) in treatment of juxtarenal abdominal aortic aneurysm (JRAAA).MethodsThe databases including the PubMed, Cochrane Library, CNKI, etc. were searched to collect the randomized controlled trails (RCTs) and non-RCTs about the F-EVAR versus Ch-EVAR for the JRAAA. The retrieval time was from inception to November 2019. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using the RevMan 5.1 software.ResultsA total of 9 non-RCTs involving 536 patients were included, 315 of whom were in the F-EVAR group, 221 of whom were in the Ch-EVARF group. The results of meta-analysis showed that: Compared with the F-EVAR group, the Ch-EVAR group had a higher incidence of type Ⅰ endoleak [OR=0.31, 95%CI (0.12, 0.85), P=0.02] and a lower incidence of target organ injury [OR=2.96, 95%CI (1.30, 6.72), P=0.010]. But there were no differences in the technical success rate, vascular restenosis, re-intervention rate, and 30 d mortality between the 2 groups (P>0.05).ConclusionsBoth F-EVAR and Ch-EVAR are safe and effective treatments for JRAAA. F-EVAR has a relative low incidence of type Ⅰ endoleak, but a relatively high incidence of target organ damage. However, for the limitation of quantity and quality of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for patients with JRAAA according to an integrative disease assessment.
This study aims to investigate whether displacement force on stents can accurately represents the displacement of the stent after endovascular aneurysm repair (EVAR) by comparing the measured stent displacement with the displacement forces calculated by computational fluid dynamics (CFD). And the effect of cross-limb and parallel-limb EVAR on stent displacements is further studied. Based on our objective, in this study, ten cross-limb EVAR patients and ten parallel-limb EVAR patients in West China Hospital of Sichuan University were enrolled. Patient-specific models were first reconstructed based on the computed tomography angiography images, then the stent displacements were measured, and the displacement forces acting on the stents were calculated by CFD. Finally, the \begin{document}$ \mathrm{cos}\;\alpha $\end{document} value of the angle between the displacement force and the displacement vector was used to analyze the matching degree between the displacement and the displacement force. The results showed that the displacement forces on cross-limb stents and parallel-limb stents were (2.67 ± 2.14) N and (1.36 ± 0.48) N, respectively. Displacements of stent gravity center, stent displacements relative to vessel, and vessel displacements of cross-limb and parallel-limb stents were (4.43 ± 2.81) mm and (6.39 ± 2.62) mm, (0.88 ± 0.67) mm and (1.11 ± 0.71) mm, (3.55 ± 2.88) mm and (5.28 ± 2.52) mm, respectively. The mean \begin{document}$ \mathrm{cos}\;\alpha $\end{document} for cross-limb and parallel-limb stents were 0.02 ± 0.66 and − 0.10 ± 0.73, respectively. This study indicates that the displacement force on the stent can’t accurately represent the displacement of the stent after EVAR. In addition, the cross-limb EVAR is probably safer and more stable than the parallel-limb EVAR.
Objective To investigate the technical feasibility and effectiveness of intraoperative sac embolizaion with coils and fibrin glue for preventing type Ⅱ endoleak after endovascular aneurysm repair (EVAR). Methods A patient with abdominal aortic aneurysm (AAA), which had high risk of type Ⅱ endoleaks, was treated with combined packing of coils and fibrin glue in order to prevent type Ⅱ endoleak after EVAR. Percutaneous catheter preset and balloon occlusion were used to ensure accurate packing. Results At the end of the operation, the angiography showed that the blood flow of the stent and distal artery was unobstructed, there was no type Ⅰ and Ⅲ endoleaks, and delayed angiogram showed no collateral circulation of aneurysm. The procedure was successful. The operative duration was 120 min and the blood loss was only 20 mL. No complications such as colonic ischemia and ectopic embolism occurred, and the patient was discharged on 3 days after operation. At 6 months after follow-up, the computerized topographic angiography showed that the aneurysm cavity was completely thrombotic, without type II endoleak, and the diameter and volume of aneurysm were reduced. Conclusions The technique of intraoperative sac embolizaion with coils and fibrin glue during EVAR is safe and effective to prevent postoperative endoleaks, which is simple and feasibility. Intraoperative indwelling catheter and balloon blocking are the key points of successful implementation of this technique.